Syncope in children

Syncope is the medical word for fainting or passing out caused by a fall in blood pressure. It is common in older children and teens. The reason typically is a temporary lack of oxygen-rich blood reaching the brain. The decreased blood flow to the brain can have a range of causes, most of them harmless. However, sometimes syncope can be a symptom of a serious heart condition.

The board-certified and fellowship-trained specialists at Norton Children’s Heart Institute, affiliated with the University of Louisville, have the experience and skill to diagnose the cause of syncope and provide care for any underlying heart condition.

The Society of Thoracic Surgeons has ranked Norton Children’s Heart Institute among the best in the region. Norton Children’s has a network of outreach diagnostic and treatment services conveniently located throughout Kentucky and Southern Indiana.

Syncope symptoms

Depending on what causes a child to faint, these are some common symptoms of syncope that could happen before loss of consciousness:

  • Pale or bluish cast to the skin
  • Blurred vision or seeing spots
  • Dizziness
  • Feeling weak
  • Feeling like the room is spinning or moving
  • Headache
  • Incontinence (involuntary urination or defecation)
  • Nausea or vomiting
  • Ringing in the ears (tinnitus)
  • Shortness of breath
  • Sweating
  • Tingling or numbness in the fingertips and around lips

Why syncope happens

Fainting or syncope in otherwise healthy children does not automatically mean a heart condition is to blame. However, even harmless loss of consciousness can cause problems. A child can get hurt during a fall after fainting or stop playing sports due to worry over fainting.

The most common reason a healthy child or teen may be dizzy or faint when standing is that the nervous system gets its signals crossed and doesn’t coordinate the blood vessels and heart like it should. In some people, this cross-firing may be triggered by things such as:

  • Dehydration
  • Dizziness
  • Extreme emotions
  • Hair-combing
  • Having blood drawn
  • Hot shower
  • Lightheadedness
  • Nausea
  • Physical strain
  • Sight of blood
  • Sudden position changes
  • Sweating
  • Vision changes after standing for a long time

When not related to a heart condition, syncope also may be called:

  • Benign or simple faint
  • Neurocardiogenic syncope
  • Orthostatic intolerance
  • Vasomotor instability
  • Vasovagal syncope

Most people who have these types of syncope don’t get dizzy or pass out every single time they experience a trigger. Instead, they often have good days (when they have minimal symptoms) and bad days (when they have more dizziness, fatigue, fainting and afternoon headaches).

Numerous kinds of congenital heart defects can cause syncope, including those that interfere with normal contractions or pumping of the heart, such as:

Conditions in which a normal heart rhythm is disrupted can cause children to faint as well, including:

  • Catecholaminergic polymorphic ventricular tachycardia (CPVT)
  • Heart block
  • Long QT syndrome
  • Wolff-Parkinson-White syndrome

Diagnosing syncope

Your pediatrician may refer your child to the specialists at Norton Children’s Heart Institute if there is a family history of congenital heart disease, inherited arrhythmia or cardiomyopathy. Or your child may be referred to a pediatric cardiologist due to:

  • Existence of a known heart, neurological or other medical condition
  • Fainting during active play or sports
  • Sudden fainting without any warning or trigger
  • Fainting accompanied by chest pain, difficulty breathing or heart palpitations
  • Fainting followed by bodily injury, seizure, tongue-biting or urinary incontinence
  • Fainting in a child age 8 or younger
  • Finding abnormal heartbeats or heart murmur during an exam

During an appointment with a Norton Children’s Heart Institute cardiologist, the physician will:

  • Take a careful health history (including details of what happens before, during and after the child faints)
  • Perform a careful physical exam
  • Order tests that can help confirm or rule out serious conditions

Tests may include:

  • Blood work and urine analysis: These tests can look for infections or conditions, such as anemia, that can cause or play a part in fainting.
  • Echocardiogram (echo): This test uses sound waves (ultrasound) to produce images of the heart and blood vessels’ structures on a screen. It can show the structure and function of the heart. Norton Children’s Heart Institute has 28 tele-echo locations throughout Kentucky and Southern Indiana.
  • Electrocardiogram (ECG or EKG): This test checks the heart’s electrical activity to show damage or irregular rhythms.
  • Holter monitor: A Holter monitor records the electrical activity of the child’s heart for 24 hours or longer to help identify a heart condition.
  • Magnetic resonance imaging (MRI): A powerful magnet, radio waves and computer create a picture of the heart or other parts of the body.

Syncope treatment

Syncope not related to a heart condition usually can be treated by paying close attention to triggers, proper nutrition and behavior. Suggested treatments to improve symptoms and reduce the chance of future episodes may include:

  • Not skipping meals
  • Identifying and avoiding triggers: For example, if the child feels dizzy and it progresses, a faint may be coming soon. The child should sit down or lie down until the dizziness passes. Some people have fewer symptoms by avoiding long, hot showers first thing in the morning. Children can take shorter and cooler showers after supper the night before when they’ve had plenty to eat and drink all day long.
  • Increase fluid intake: We often recommend a teenager drink at least two 12-ounce glasses of noncaffeinated beverage at breakfast, lunch and supper, and try to drink even more between meals.
  • Increase salt in the diet (sodium, not potassium): Salt helps the body hold onto fluids. Note: Increasing salt may not be a good idea for children with pre-existing high blood pressure, heart failure or kidney disease.
  • Regular exercise (focus on the legs): Exercise helps the body’s ability to handle blood flow to the brain when you’re standing up.

Children who continue to have symptoms after these treatments may benefit from one or more medications (for example, fludrocortisone, midodrine, beta blockers or selective serotonin reuptake inhibitors [SSRI] agents). The good news is that this condition is usually temporary. Most children and teens eventually outgrow it.

Children who have syncope due to a congenital heart defect or disease will need treatment based on their specific heart condition. The Norton Children’s Heart Institute team can help develop a treatment plan that is unique for each child, which may include treatments such as catheter ablation, placement of a pacemaker or cardioverter-defibrillator, or heart surgery.

Why Norton Children’s Heart Institute?

Norton Children’s Heart Institute, affiliated with the University of Louisville, is a comprehensive pediatric heart surgery, heart failure and heart transplant program serving Kentucky, Southern Indiana and beyond.

The goal of the full-service Norton Children’s Heart Institute is to provide care for the child and the whole family. Our specialists are prepared to repair even the most complex congenital and acquired heart conditions.

Our heart team includes:

  • Pediatric cardiothoracic surgeons
  • Pediatric transplant surgeons
  • Pediatric cardiologists
    • Fetal cardiologists
    • Adult congenital heart cardiologists
    • Heart failure/heart transplant cardiologists
    • Pediatric electrophysiologists
    • Pediatric cardiac catheterization cardiologists
  • Pediatric cardiovascular anesthesiologists
  • Pediatric intensive care physicians
  • Cardiac critical care nurses
  • Critical care pharmacists
  • Family support team
  • Child life specialists
  • Rehabilitation specialists
  • Social workers
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